Publications by authors named "Komukai S"
The judicious selection of ovulation inhibitors in ovarian stimulation protocols is crucial for the success of assisted reproductive technology (ART). Herein, we investigate the dose-dependent effects of chlormadinone acetate (CMA) and cetrorelix, two distinct ovulation inhibitors, on oocyte maturation in patients with normal ovarian reserve, using univariable and multivariable Poisson regression analyses. Patients undergoing progestin-primed ovarian stimulation (PPOS) with CMA (n = 299) or gonadotropin-releasing hormone antagonist (GnRH-ant) with cetrorelix (n = 605) during their initial in vitro fertilization cycle were enrolled at our center from March 2018 to October 2020 (N = 904).
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- Anticholinergic drugs may lead to cognitive impairment, and this study specifically examined their risk of causing dementia in older adults in Japan compared to beta-3 agonists.
- The study involved over 1.4 million participants, with nearly 13,500 taking anticholinergics and around 24,700 using beta-3 agonists, all aged 65 and older with overactive bladder.
- Results indicated that users of anticholinergic drugs had a 22% higher risk of developing dementia compared to those using beta-3 agonists, suggesting a significant association between anticholinergic use and increased dementia risk.
Article Synopsis
- Event-driven trials maintain the target power for treatment effects by focusing on obtaining a required number of events, but they may take longer if the actual event rate is lower than expected.* -
- Blinded sample size reestimation (BSSR) uses interim data to adjust sample sizes if initial assumptions are incorrect, aiming to achieve the necessary number of events within the planned timeline.* -
- A new flexible spline-based BSSR method, specifically the Royston-Parmar model, shows improved accuracy in predicting event counts compared to traditional parametric models, as evidenced by simulation studies and real trial applications.*
Article Synopsis
- - The study investigated bronchiectasis (BE) in Asia, focusing on clinical features, treatment outcomes, and the impact of nontuberculous mycobacteria (NTM) infections on patient prognosis.
- - Analyzing medical records from 1044 BE patients over 3 years revealed a 22.3% severe exacerbation rate and a 3.2% mortality rate, with 39.3% of patients having NTM infection, which did not significantly affect the timing of first severe exacerbations or mortality.
- - Among patients with non-NTM infections who hadn't experienced past exacerbations, 38.2% took long-term macrolide antibiotics, but this treatment did not noticeably extend
Variability of macrolide-resistant profile in complex pulmonary disease.
Antimicrob Agents Chemother
November 2024
Article Synopsis
- The study investigated macrolide resistance in 68 patients with complex pulmonary diseases, focusing on how treatment affected resistance profiles.
- Among patients not treated with macrolides, over half (52%) reverted to being susceptible to macrolides, while only a tiny fraction (2%) of those continuing treatment saw similar results.
- The analysis of 30 resistant isolates revealed that seven had shifted to susceptible profiles, with reasons including related strains or reinfections.
Article Synopsis
- This study investigated how a patient's health status before experiencing sepsis affects their recovery and mortality one year after discharge, focusing on a large population in Japan.
- Researchers categorized the pre-sepsis care needs of 17,648 patients into several levels, revealing that higher care needs were linked to increased mortality rates and changes in post-discharge care requirements.
- The findings suggest that patients with greater pre-sepsis care needs face a higher risk of death and intensified care needs within a year after being discharged from the hospital.
Article Synopsis
- This study investigates the relationship between aortomitral anatomical variations and the risk of conduction disorders in patients undergoing mitral valve surgery.
- Researchers analyzed 147 patients using 3D echocardiography and found that the aortic root's positioning significantly impacts the likelihood of postoperative conduction issues.
- Specifically, patients with lateral aortomitral appearance and lateral rotation of the aortic root had a notably higher incidence of these disorders compared to those with a center appearance and rotation.
Article Synopsis
- The study investigates the link between care needs levels (CNL) at hospital discharge and outcomes in older patients with acute heart failure (aHF), highlighting that those with higher CNL are at greater risk for worse post-discharge outcomes.
- A cohort of over 17,000 patients aged 65 and older was examined, categorizing their CNL into four levels based on their daily care needs at the time of hospitalization.
- Results revealed that nearly all patients’ care needs worsened after discharge, with increased risks of mortality for those with higher levels of care needs, indicating that higher CNL at hospitalization correlates with a significantly higher risk of death within a year.
Article Synopsis
- Identifying and adjusting for confounders is essential in observational studies to accurately estimate causal effects, as biases can lead to misleading results, even with large sample sizes.
- The article discusses various methods to select confounders, highlighting the modified disjunctive cause criterion, which aims to control for pre-exposure covariates that influence the exposure or outcome while excluding instrumental variables.
- It also addresses challenges in measuring confounders, introducing the E-value and Robustness value to evaluate sensitivity to unmeasured confounders, with examples drawn from the National Health and Nutritional Examination Survey.
Article Synopsis
- Previous research suggests a potential link between statin use and a lower risk of dementia, but this has not been clearly established in Japan's aging population.
- This study analyzed data from the LIFE Study, focusing on Japanese participants aged 65 and older, to investigate this association more thoroughly.
- Results showed that statin users had a significantly reduced risk of dementia and Alzheimer's disease, with higher cumulative statin doses offering greater protective benefits compared to non-users.
Article Synopsis
- The study investigated the relationship between statin use and Parkinson's disease risk in Japanese individuals aged 65 and older, using data from the Longevity Improvement and Fair Evidence Study.
- Results showed that statin use was inversely associated with the risk of developing Parkinson's disease, suggesting a protective effect, especially with higher cumulative doses of statins.
- Specifically, lower doses correlated with an increased risk, while higher doses were linked to a decreased risk of Parkinson's disease among older adults in Japan.
Article Synopsis
- This study compares the effectiveness of two strategies for pediatric out-of-hospital cardiac arrest (OHCA): intra-arrest transport (moving a patient to the hospital during CPR) versus continuing on-scene CPR until the resuscitation effort is complete.
- The research analyzes data from pediatric patients treated by EMS from 2005 to 2015, with a focus on how these strategies impact survival rates after cardiac arrest.
- Findings reveal that 66.3% of the children underwent intra-arrest transport, and the study aims to determine if survival outcomes differ based on the timing of transport and patient age.
Article Synopsis
- The study focused on creating a tool to assess the risks of bleeding and thrombosis in patients with myocardial infarction undergoing percutaneous coronary intervention (PCI).
- It involved analyzing data from two patient cohorts: one for developing the tool (4554 patients) and another for validating it (2215 patients).
- The resulting model effectively stratified patients based on their risk probabilities, aiding in tailored treatment decisions for both STEMI and non-STEMI cases.
Article Synopsis
- The text discusses the challenges of estimating causal effects in nested case-control studies using marginal structural Cox models (Cox-MSMs) with inverse probability weights (IPWs) due to non-random sampling and potential insufficient subjects.
- To address these issues, a new method is proposed that calculates IPWs through pseudo-likelihood estimation, requiring additional data from subjects with treatment changes and censored follow-ups, simplifying the process to covariate histories.
- The method's effectiveness was validated through a simulation study and an application to a study on statins and coronary heart disease, highlighting its usefulness in assessing time-varying treatment effects.
Article Synopsis
- The study investigates the role of prehospital systemic corticosteroid administration by EMS clinicians in treating asthma exacerbations, particularly its effects on hospitalization and length of stay in the hospital.
- Researchers analyzed data from over 15,000 EMS encounters, finding that nearly 30% of patients received corticosteroids before reaching the hospital, with several factors influencing administration rates.
- The results suggested that while prehospital corticosteroid use did not significantly reduce overall hospitalization or length of stay, it showed potential benefits for specific patient groups during longer EMS encounters and those with certain symptoms like wheezing.
Article Synopsis
- The study investigates the best sequence for administering epinephrine and advanced airway management (AAM) during out-of-hospital cardiac arrest (OHCA) to determine its impact on patient survival outcomes.
- Conducted on a large cohort from a national OHCA registry in Japan, the research focused on adults aged 18 and older who received either or both treatments from emergency services between 2014 and 2019.
- Results showed that patients who received epinephrine before AAM had significantly better survival rates after one month, regardless of whether their initial heart rhythm was shockable or nonshockable.
Article Synopsis
- The study aimed to analyze how the duration of cardiopulmonary resuscitation (CPR) affects outcomes for patients who experience in-hospital cardiac arrest, focusing on survival rates and health status upon discharge.
- It was a retrospective cohort analysis involving nearly 349,000 adult patients who underwent CPR between 2000 and 2021 in a multicenter US registry, examining the relationship between CPR duration and the likelihood of survival and functional recovery.
- Key findings revealed that 66.9% of patients achieved return of spontaneous circulation after a median of 7 minutes of CPR, while 22.6% ultimately survived to discharge, highlighting the critical role of timely and continued resuscitation efforts.
Article Synopsis
- A study in Japan aimed to investigate the relationship between anticholinergic drugs and the risk of dementia in older adults, focusing on a population over 65 years old.
- The research analyzed claim data from 2014 to 2020, including nearly 67,000 dementia cases and 329,000 matched controls, revealing that those prescribed anticholinergic medications had a significantly higher likelihood of being diagnosed with dementia.
- Specific drug types linked to increased dementia risk included antidepressants, antiparkinsonian drugs, antipsychotics, and bladder antimuscarinics, indicating a need for careful prescription in the aging population.
Article Synopsis
- ECPR is being explored as a potential life-saving treatment for patients who experience out-of-hospital cardiac arrest (OHCA), focusing on how it impacts survival and brain function outcomes.
- The study analyzed data from a large registry, comparing ECPR-treated patients with a control group and considering factors like initial heart rhythm (shockable vs. non-shockable) to evaluate the effectiveness of ECPR.
- Results indicated that ECPR significantly improved survival rates after 30 days, particularly for patients with non-shockable rhythms, suggesting further research is needed to explore its full potential and identify the best candidates for this treatment.
There is limited evidence regarding the association between graft-versus-host disease (GVHD) and reduced relapse in patients who undergo allogeneic hematopoietic stem cell transplantation from haploidentical donors (haplo-HSCT) using post-transplant cyclophosphamide (PTCY). We investigated the association between GVHD and transplant outcomes in 938 patients who received haplo-HSCT using PTCY. Overall survival (OS), relapse rate, and non-relapse mortality (NRM) were evaluated using landmark analysis at the landmark points at 100 and 360 days after HSCT for acute and chronic GVHD, respectively.
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- Allogeneic hematopoietic stem cell transplantation (HCT) is a potential curative treatment for patients with myelodysplastic syndrome with a complex karyotype (CK-MDS), although there are limited studies focusing on this specific group.
- In a study involving 691 CK-MDS patients, the overall survival (OS) rate after 3 years was found to be 29.8%, with various factors impacting survival rates.
- Key risk factors linked to reduced OS included older age, male sex, poor comorbidity index, a need for red or platelet blood transfusions, incomplete remission, a high number of karyotype abnormalities, and the presence of a monosomal karyotype.
Article Synopsis
- The study focuses on heart failure with preserved ejection fraction (HFpEF) and aims to understand the differences in biomarkers among its various phenotypes to shed light on their underlying mechanisms.* -
- It utilizes data from the PURSUIT-HFpEF Study, which includes 1,231 patients, and identifies four distinct HFpEF phenotypes based on biomarker measurements from a subset of 212 patients.* -
- Results show that each phenotype has unique biomarker profiles, suggesting differential pathophysiological mechanisms, particularly the role of inflammation in conditions like hypertension and cardiac hypertrophy.*
Article Synopsis
- The study investigates the long-term effects of complete versus incomplete revascularization in patients with ischemic cardiomyopathy who underwent coronary artery bypass grafting.
- It found that patients who received complete revascularization had a significantly higher 5-year survival rate and lower risk of death or readmission due to heart failure compared to those with incomplete revascularization.
- Additionally, complete revascularization led to a greater improvement in heart function as measured by left ventricular ejection fraction one year after surgery.
Article Synopsis
- The study investigates the recent prevalence of hepatitis delta virus (HDV) infections among patients with hepatitis B virus (HBV) in Japan, as it has not been updated for over two decades.
- Researchers screened 1,264 HBV patients at Hokkaido University Hospital, concluding that 1.7% had detectable anti-HDV antibodies.
- The findings indicate that those with anti-HDV antibodies had a higher prevalence of liver cirrhosis and experienced faster progression of liver fibrosis, emphasizing the need for routine HDV testing in similar patients.
Article Synopsis
- The study aimed to investigate the occurrence, predictors, and effects of ventricular arrhythmias following coronary artery bypass grafting, as well as the role of implantable cardioverter defibrillators (ICDs) in improving patient survival.
- Out of 498 patients with reduced ejection fraction who underwent surgery, a significant number (43%) died mainly from heart failure and sudden cardiac death, with postoperative ventricular arrhythmias developing in 20% of cases.
- Patients with ventricular arrhythmias who received ICDs had a much higher 5-year survival rate (76.1%) compared to those who did not have an ICD (22.7%), indicating the critical importance of timely ICD implantation to enhance patient outcomes.